3 August 2016
During a routine inspection
The service provides care and support to people in their own home. Care is provided by staff who visit throughout the day and night, as well as live in care for some people. At the time of our inspection 68 people were receiving a service.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We brought the inspection of this service forward in response to information we received regarding an incident during which a person received a serious injury. During the inspection we found that the service was operating effectively and well in most areas. However we also established that the incident that had been brought to our attention had not been well managed in that risks had not been effectively assessed, actions taken were not appropriate and the management response indicated a lack of clear systems which was a concern to us. Although this was an isolated incident the seriousness of it has informed the judgements in this report.
Staff had received training in safeguarding people from abuse and understood their responsibilities. However one safeguarding concern (regarding the incident mentioned above) had not been appropriately referred to the local authority.
The service assessed risk well and provided clear guidelines for staff to help reduce the likelihood of risk. However this had not been the case for one person who sustained a serious injury and actions taken in response to the incident did not effectively manage the incident.
Staffing levels were assessed and kept under review. There was a recruitment procedure in place which ensured that staff were safe to carry out this kind of work and had the required skills and experience.
Medicines were administered safely and records related to medicines were accurate.
Training and support was provided for staff to help them carry out their roles and increase their knowledge about the health conditions of the people they were caring for. There was a robust induction process which trained, monitored and supported staff. Additional and specialist training was provided for staff to enable them to support people with complex health needs.
People gave their consent before care and treatment was provided and staff had received training in the Mental Capacity Act (MCA) 2005. The MCA ensures that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process.
People were supported with their eating and drinking and staff helped to ensure that people had access to the food and drink they might need after staff had left for their next call. Staff also supported people with their day to day health needs and worked in partnership with other healthcare professionals.
Staff were caring and people were treated respectfully and their dignity was maintained.
People were involved in planning and reviewing their own care and were encouraged to provide feedback to enable the service to learn and grow. There was a commitment to preserving people’s own skills to maintain their independence.
Formal complaints were managed well. Informal complaints, gathered as a result of the regular feedback the service encouraged, were dealt with promptly and to the satisfaction of the people raising the issue.
Staff understood their roles and were well supported and valued by the management team. There was an open and positive culture which staff and people using the service valued. The management team demonstrated a commitment to using innovative practices to improve the service.
Quality assurance systems were in place to monitor the delivery of the service. However one serious incident had not been effectively managed or investigated by the provider and relevant authorities had not been notified.
We found several breaches of regulations during this inspection. You can see what action we have told the provider to take at the back of this report.